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Home My WebLink About0225 LEWIS POND ROAD - Health 225 LMIS POND ROAD Cotuit �--- - — - - --- ---- -- -- - A = 020 - 121 Commonwealth of Massachusetts � �f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, ilk I use only the tab 1. Inspector: key to move your q. cursor-do not Matthew F. Gilfoy ' use the return key. Name of Inspector B&B Excavation k 1� 11 Company Name 14 Teaberry Lane: Company Address Sandwich Ma. 02644 Cityrrown State Zip Code (508)477-0653 S131640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: , ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation.by the Local Approving Authority 6/23/14 Inspector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent.to the buyer, if applicable, and the,approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 W V V t5ins•3/13 Title 5 Official Inspection Wm: bsurface Sewage Disposal System•Pa e 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name • information is required for every Cotuit MA 02635 6/20/14 page. Cltyrrown State Zip Code. Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon.completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over:20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑. Y ❑ N ❑ ND (Explain below): t5ins 3/13 Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary.Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page.e. Cityrrown State Zip Code : Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System,will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or.replaced ❑ Y ❑ N ❑ ND (Explain below): Y q pumping Y pipe(s'). ❑ The system requiredmore than 4 times a year due to broken obstructedThe system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced - ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health:. ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..°" 225 Lewis Pond Road Property Address Christopher Rogers l Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"', Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5im-,3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..°' 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityrrown State Zip Code Date ofInspection B. Certification (cont.) Yes No Required pumping more,than 4 times in the last year NOT due to clogged or E] 0.1 obstructed pipe(s). Number of times pumped: ❑ ® „ Any portion.of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well.water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody,must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The. system owner.should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To,be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system Iis within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking.water supply El. El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat,. or answered "yes" in Section D above the large system has failed. The owner or operator-of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ 1 Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? Z ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ElWere as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example; a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to.Part C is at issue approximation of distance is unacceptable) [310.CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3. Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityrrown State Zip Code. Date of Inspection D..System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection 0 Yes ® No information in this report.) Laundry system inspected? Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes 0 No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments .�' 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use:- Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑: Tight tank..Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is Cotuit MA 02635 6/20/14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1'1011 Depth below grade. feet Material of construction: El cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction,line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order. No sign of leakage. Septic Tank(locate on site plan): Depth below grade: 2'10"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list.age .years Is age confirmed by a Certificate of Compliance? (attach:a copy of certificate) ❑ Yes ❑ No `f Dimensions: .. 1500 gal. 311 Sludge depth: t5ins-3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1„ Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 161. scour stick How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order. Tees present- No sign of back-up. I i Grease Trap (locate on site plan): Depth below grade: . feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)': Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle I Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grader Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: - - gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑..Yes ❑ No . Date of last pumping: Date Comments(condition of alarm and float switches, etc.): . i "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins,•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r yv.,y 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and.distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to in working order. No sign of deterioration or carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):. ' If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS),(locate on site plan, excavation not required): If SAS not located; explain why: t5ins;•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits. number: ® leaching chambers number: (2) 500 gal. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool - number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching is dry and appears to be in working order. No sign of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer. Depth of scum.layer Dimensions of,cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins;•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every COtUIt MA 02635 6/20/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth:of Massachusetts Title 5: Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments gwis;P�•. P operty Address ond Road Christopher Rogers . Owner Owner s Name information is required for every .Cotuit - MA 026M 6/20/14 page. c4r.rown. State Zip Code Date of Inspection. D System lnforrnation;(Cont.) Sketch Of Sewage Disposal System: Provide a.view of the sewage disposal system, including ties to at'Ieast.two:permanent reference landmarks orbenchmarks: Locate all wells within 100 feet.Locate where..public water:supply enters the building..Check:.one of the.boxes below: 9 hand-sketch in the:area.below 0 drawing attached separately �.ONT Po�C. Fj i — I . I(Do �1 1� At 1.3 r T t5ins•3M3 Title 5 Official:Inspection Form:Subsurface Sewage Disposal System•'Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection- Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells - >132" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: April 1998 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with.local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file : Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "< 225 Lewis Pond Road Property Address Christopher Rogers Owner Owner's Name information is required for every Cotuit MA 02635 6/20/14 page. Cityfrown State Zip Code. Date of Inspection. E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ®Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System.Information:-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS A EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ' PART A CERTIFIC ATION 211 Property Address:225 Lewis Pond Road Barnstable(Cotuit).MA ' Owner's Name: Michele Farrell Rovers i Owner's Address: 20 Russell Rd h Falmouth,MA 02540a Date of Inspection: April 6,2006 Name of Inspector: Gary J and/or Jane E Rabesa Company Name:Rabesa Subsurface,Inc dba Warren Cesspool Service Mailing Address: PO Box 2302 Teaticket,MA 02536-2302 Telephone Number: 508-540-7143 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I an a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date:April 26,2006 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: Title V system in working condition. The tank was pumped after inspection for maintenance. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:225 Lewis Pond Road _Barnstable(Cotuit).MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. B. System Conditionally Passes: NO One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: " The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Warren Cesspool Service 508-540-7143 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 C. Further Evaluation is Required by the Board of Health: NO. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100"feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory',for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other:, Warren Cesspool Service 508-540-7143 T41. G ci,)nnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rovers Date of Inspection: April 6,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must serve a facility with a desi¢n flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply' the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Warren Cesspool Service 508-540-7143 T41. f 1--+;— r.'nr..,4/1 G/7nnn 4 Page 5ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x — Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of this inspection? x Were as built plans of the system obtained and examined?(If they were not available note as N/A) x Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out ? x_ Were all system components,excluding the SAS,located on site?' x_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? x _ Was the facility owner(and occupants if different from owner)provided with information on the proper . maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no x Existing information.For example,a plan at the Board of Health.. x _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of Ti—stance is unacceptable)[310 CMR 15.302(3)(b)]. Warren Cesspool Service 508-540-7143 T410 c 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):three Number of bedrooms(actual):three DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 gpd(357.3 provided) Number of current residents:one Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no[if yes separate inspection required] Laundry system inspected(yes or no): n/a Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)):2004: 241 gpd;2005: 255 gpd. Sump pump(yes or no): no Last date of occupancy: occupied: COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow(based'on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: (owner)none. Was system pumped as part of the inspection(yes or no): ves If yes, volume pumped: 1500 gallons--How was quantity pumped determined?Site glass Reason for pumping: recommended maintenance TYPE OF SYSTEM x Septic tank,distribution box;soil absorption system —Single cesspool Overflow cesspool Privy _no_Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1998 permit on file. Were sewage odors detected when arriving at the site(yes or no): no Warren Cesspool Service 508-540-7143 T41. r•__ui ci,)Ann 6 ,F Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 BUILDING SEWER: (locate on site plan) Depth below grade:24" Materials of construction: cast iron x 40 PVC other(explain): Distance from private water supply well or suction line: town water line 24'. Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X(locate on site plan) . . i Depth below grade: 18"inlet cover/5"outlet cover(over 12" risers) Material of construction: x concrete_metal fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach`a copy of certificate) Dimensions: standard 1500 gallon septic tank Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle: 16" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: onsite Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tank has no failure criteria. The DEP recommends pumping every three years,depending on use. The tank was pumped after inspection.. GREASE TRAP: NO(locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Warren Cesspool Service 508-540-7143 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 TIGHT or HOLDING TANK: NO(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): ,,,. Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: YES(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Viewed by remote camera,no failure criteria noted. The cover has not been raised and is 25" below grade. PUMP CHAMBER: NO(locate on site plan) Pumps in working order(yes or no):------- Alarms in working order(yes or no):-------- Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Warren Cesspool Service 508-540-7143 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:225 Lewis Pond Road Barnstable(Cotuit),MA Owner: Michele Farrell Rogers Date of Inspection: April 6,2006 SOIL ABSORPTION SYSTEM(SAS): YES (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: {� x leaching chambers,number:two , „ leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: p Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): From engineered plan on file,there are two 500 gallon dry wells with four feet of stone around. Viewed by remote camera,there are no previous failure signs. Grade to top of leaching is two feet. CESSPOOLS: NO(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:---------- Depth—top of liquid to inlet invert:-------- Depth of solids layer:---------- Depth of scum layer:---------- Dimensions of cesspool:------------ - Materials of construction:----------------. Indication of groundwater inflow(yes or no): no Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: NO(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure;level of ponding,condition of vegetation,etc.): Warren Cesspool Service 508-540-7143 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address:225 Lewis Pond Road Barnstable(Cotuit) MA Owner: Michele Farrell Ro ers Date of Inspection:Agrii 6.2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water is greater than 12 feet Please indicate(check)all methods used to determine the high ground water elevation: x Obtained from system design plans on record-If checked,date of design plan reviewed: 1998 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: previous inspection on file Checked with local excavators,installers-(attach documentation)En i r' on Accessed USGS database-explain:town topoeranhv maps.USGS survey mans You must describe how you established the high ground water elevation: From engineered plans on file,no groundwater found 144"below grade in April 1"S. q i {3IbTmrn of L4E*cH/06— Warren Cesspool Service e 508-540-7143 qA 1 q.? � T:flu G innnui.*inn Timm!./1 GhMf1 I1 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:225 Lewis Pond Road Barnstable(Cotuit).MA Owner: Michele Farrell Rogers Date of Inspection:Aorll 6,2006 SKETCH OF SEWAGE DISPOSAL SYSTEM NOT TO SCALE Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building FXoW- A A � - 3116U 61- 18 1 R�- aY 61- ao, - � o C33 3� z Warren Cesspool Service 508-540-7143 Titla 4 »a»o.+in»T.nwm 4/1;/,)nA► 10 OWN OF BARNSTAB (W LOCATIONd SEWAGE # V VILLAGES ASSESSOR'S MAP & LOT v 0 —�a INSTALLER'S NAME&PHONE NO. q-7 -0177 SEPTIC TANK CAPACITY !SLR LEACHING FACILITY: (type) <�r;�t�,� — (size) _,��_ NO.OF BEDROOMS 6 BUILDER OR OWNER�' Tl��at sn PERMUDATE:_ -� -L` _COMPLIANCE DATE: -• A I -� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet=,% V Feet Furnished by0 to n�'�''� I ' t < � Q 4 TOWN OF BARNSTABLE LOCATION �,�(�/�S T e 14/-b Jel) SEWAGE# 9y a3a -X VILLAGE COTlu/i ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. WO,-S i5:X i4 SEPTIC TANK CAPACITY /SZFd ST LEACHING FACILITY.(type) J0-D (/�/AX IIS � (size) o7x S� 1 NO. OF BED/RyO�OMS I, OWNER C f0VUCZr PERMIT DATE: /3-9S-' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist � within 300 feet of leaching facility) Feet FURNISHED BY G-f}/C'%ilPo9 FxovT- po�-cH t . — f I � 3b� �� i t33 o 2 + OWN OF BARNSTABLE LOCATION SEWAGE # VI.LAGS � ASSESSOR'S MAP& LOT C) 44 INSTALLER'S NAME&PHONE NO. `7 •GT,77 SEPTIC TANK CAPACITY i ram_ j LEACHING FACILITY: (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE:_ -�:3 - _COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leac aci ' ) Feet Furnished by 4 c 1 a w t +No. Fee e/C✓� � lJ V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS � ; � Zipprication for �N!6po5al *pgtem �tCon5truction Permit S. plication is hereby made for a Permit to Construct X)or Repair( )an On-site Sewage Disposal System at: ocation Address or Lot No, Owner's Name,Address and Tel.No. C,4J9rg+ A4x6HCG-"-' Ipd( i2S IN Installer's Name,Address,and TeILNo. Designer's Name,Address and Tel.No. /21g�1� �xc �1� 466--t ASsBG- p O 3 Z 1 Type of Building: Dwelling No.of Bedrooms Garbage Grinder( j Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Cal ted daily flow gallons. Plan Date cu a Numb L ] Number of sheets Revision Date y� Title 4ZPg S � � 1, A �>6 /� li►p 11 „,. 1 Description of Soil 6 Go/V Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date q'`3 Application Approved by 17 Application Disapproved for the following reasons Permit No. 9 23 Date Issued /- — c� 9F z 3 2 / C Z Fee a�'-�'. .. No. THE Coy `WEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION TOWN OF BARNSTABLEs MASSACHUSETTS Z[pp( ca0ou for Mi.5poal *p!5tem Cott!9truction Permit Application is hereby made for a Permit to Construct )or Repair( )an On-site Sewage Disposal System at: �� Location Address or Lot No. Owner's Name,Address and Tel.No. S J —'W rt: Installer's Name,Address,and TeL No. pDesigner's Name,Address and Tel.No. R� L � � /219ir1s (G4� /11�' A SSl�G. �1L8=3�3 p �4�?Ix3,6 1 34'R G Type of Building: Dwelling No. of Bedrooms Garbage Grinder( � Other -----Type of Building No.of Persons Showers'( ) Cafeteria( ) Other Fixtures r Design Flow gallons per day. Cal cu ated daily flow gallons: f Plan Date k8pall 71 , qfz Number of sheets Revision Date y� Title MAN dQOPM6P 8M6 S Zug Description of Soil � r �i t i it S -«� '` /� S G Nature of Repairs or Alterations(Answer when applicable) j ' 1 i z � Date last inspected: Agreement: i The undersigned agrees to ensure the construction`and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. ' Signed c^ Date q'/.3—7 t Application Approved by ,C _ w Application Disapproved for,the following reasons i Permit No. Z 3 3 Date Issued ' '"a— !' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed or repaired/replaced( )on y for as Z ZK 6:t1l A V V_c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. I —2-F-7 dated Use of this system is conditioned on compliance.with the rovisions set forth below: No. / Cl Z J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �Bigaal *p$tem Cougtruction Permit Permission iXhbly granted toto construct epair( )an On-site Sewage System located at Z/� adl 7�<a� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local.provisions or special conditions. All construction /must be completed within two years of the date below. �^— Date: -Approved by I soils: PROFILE OF Pere Test SEWAGE DISPOSAL SYSTEM Test Date: 26/MAR/98 Board of Health: Jerry Dunning EL=143' NOT TO SCALE Engineer: Edward L. Pesce ]EST PIT #1 Representing: Pesce Engineering :'•�: EL=141' Horizon Texture Color PO Box 321 0 140.8' Osterville MA R 2" LAYER OF 2" Excavator: J P. Macomber 4" SCH. 40 PV iser ]f8"-1/2" WASHED ...... ...................... ................... 140.6' 1 --ConcreteR' EL=141' STONE v 8" A Loamy Sand 140.1`a ;: 4" SCH. 40 PVC ...... ..... .... SLOPE .02 (1/4" PER FT.) TEST PIT #2 ;•,': 10" FLOW LINE EL=138.5' Loam Sond Horizon Texture Color + EL=139.T B Y lOYR 6/6 14T o 28. 138.-4 0 141.3' ` z 1 O 0 0 O EL 139. MIN 48" L 139.1' 6" Q h. 7" A Loamy Sand 140.7 ``�'' :......,�:,... ,•.. .: ' � 24" ,,... .. Med Sand C W/Trace 2.5Y 7/4 ? 10' min 10.5' EL=138.9' EL=138.7' Gravel Distribution 8-6 ' Loamy Sand FOUNDATION SEP77C TANK Box B 10Y R 7/8 ti` EL=136.5' 25' 26" ....... ...:..............., ... ...... 139.1' v, - 1,500 GALLONS (H--10) 144'° No Water 128.8' � (H-10) ' Cb 2 500 GAL DRYWELLS 3/4" To 1-1/2" Med Sand a WASHED STONE C W/Trace 2.5Y 7/4 Gravel 2" LAYER OF 132" No Water 130.3' 1�8"-1/2" WASHED TONE Perc test waved (assumed rate: < 5 min/in) W SHED STONE S E" Design Calculations: 12" MIN \ fir? Sep tic Tank: • � Design Flow (no garbage disposal): L e ,S Pon d Roa,r� 3 Bedrooms X (110 GPO) X 2009 = 660 GPD EL=136.5 5'-2" 4 (,/ Use 1,500 GAL (H-10) Septic Tank ' 13-2" S 680250" E s Leaching Facilities: 9 o 1 80 EL=128.8 Bottom of Test Hole i/ � �y2• , Lot 180 � ( � - Design Flow For Leoching: / m 3 Bedrooms X (110 GPD) = 330 GPD J/ \33,3O0±S DRYWELL END VIEW Use 2-500 GAL Drywells (w/4 crushed stone) y#ono Sidewalk 2(25' + 13.2')(2')(.74GPD/SF) = 113.1 GPD A.yG/ 2j o s�o /s S i / U Bottom: (13.2)(25)(.74 GPD/SF) = 244.2 GPD c 357.3 GPD > 330 GPD Garage _ GENERAL NOTES: 1.) PLAN REFERENCE PB 162185. PROPO 2.) THIS PLAN IS FOR THE INSTALLATION OF A NEW SEPTIC SYSTEM 1soo c s� Proposed 3_Bedroom AND NOT IS TO BE USED FOR SURVEYING OR ZONING PURPOSES. i `� �. , � _: �- �� , Dwelli,5g o `t f 3.) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. cPa,�o^?� 1 t TITLE 5 AND THE TOWN OF BARNSTABLE RULES 'AND REGULATIONS •� N_1O� �n � ; ; FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 4.) ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN F ,� ' 12" OF FINISHED GRADE. 14> CS, Qp I f� 5.) EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME, c� / A/ UNLESS NOTED BY FINAL CONTOURS. 140 6.) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF ?floocs. WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED 139 oo, UNDER OR WITHIN 10' OF DRIVES OR PARKING UNLESS NOTED. 7.) ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTERED IN PLACE. \A 2 / aSe ,• '/ r 8.) ALL PIPE TO BE 4" SCH 40 PIPE. 0. //Q�aP 9.) THIS DESIGN DOES NOT INCLUDE USE OF A GARBAGE DISPOSAL. References: Assessors Map 20 Parcel 121 �� / Deed Book 5540/330 °o ,� / / ,/ / / / /� �50 (,h Plan Book 162185 / R��c , , i / , / - PLAN SHO WING PROPOSED Zone RF /� �/ e �1 l� N Z��,,\ Setbacks `� Fo / / ,ti5 ,�,;; / / ti°� e P \; HOUSE & SEPTIC SYSTEM iron t - 30 g 0� / / / / / / ,j�' / / / / ti� ' A o �� side & rear - 15' / / / / �, / / / / / / �. {I Z A T o2a l S GA y r LOCUS N .I LEW! POND / // O D L ST I BARNSTABLE (cotuit) , MASS Aquifer Protection District GP � , / �/ / / / / � �'•�, ,� , FEMA Zones C /, Community Panel Number // / / /// ///� -� + /�^ I ceAIT > 250001 0021 D / ,/ // / / /// ;i�•'#3 �- -�0"�/ ; �' DATE. April 11, 1998 Scale; 1 =30 Pesce PREPARED FOR: Approximate Location of / / // , , �o�y�N O P/�P Engineering & Associates cap(BSU l Chris & Michele Rogers 100 year Flood Plain / //�� 1� /0Pe PO Box 321 PO Box 718 9 oh��5 Osterville, MA 02655 Hyannis MA 02601-0718 � / (508) 428-3730 (508) 790-7902 (508) 790-7905 fax Wetland Resource Area / �• LOCATION MAP (12000'f) As Flagged byy FES 6 Field: RRL RJM Date: APR 98 (Edge of BVW) • ' # Old Cranberry 9 Bo Calc./Design: ELP Draft: RRL so o �s so so yzo . (as shown on Plan of Record 162185) Review: ELP #� 1 1 File: C274P1 SHEET OF }